摘要
目的 探讨糖尿病患者阴茎增粗术后全层皮肤坏死创面的原位再生修复方法与临床效果，为男性外生殖器难治性创面提供保器官、保功能的治疗策略。方法 回顾性分析1例48岁2型糖尿病患者，行阴茎背深静脉包埋术+脱细胞牛心包补片置入增粗术后，继发铜绿假单胞菌感染，致龟头及阴茎背侧全层皮肤坏死。传统清创、抗感染、生长因子治疗6周无效后，采用巴克组织细胞原位再生修复技术，遵循“不切除、不烧灼、不擦拭”原则，予专用洗液冲洗、全愈禾膏动态换药、巴克无菌敷贴覆盖，联合血糖控制与抗感染治疗，观察创面愈合及器官功能恢复情况。结果 经30天原位再生修复，患者全层皮肤坏死创面完全生理性愈合，阴茎静息状态周径恢复至术前92%，未出现尿道损伤、勃起功能障碍等严重并发症，避免了阴茎部分切除。结论 组织细胞原位再生修复技术可安全、有效修复糖尿病合并感染所致阴茎全层皮肤坏死创面，在保护器官完整性、恢复生理功能方面具有明显优势，可为男性生殖器难治性创面提供新的临床思路。
关键词： 阴茎增粗术；原位再生；糖尿病创面；创面修复；皮肤坏死
Abstract
Objective To investigate the method and clinical effect of in situ regeneration repair for full thickness skin necrosis wound after penile augmentation in diabetic patients, so as to provide an organ preserving and function preserving strategy for refractory wounds of male external genitalia. Methods A retrospective analysis was performed on a 48 year old male patient with type 2 diabetes mellifluous, who underwent penile root deep dorsal vein embedding, and acellular bovine pericardium patch augmentation. Full-thickness skin necrosis on the glans and dorsal penis occurred secondary to Pseudonym oleaginous infection. After 6 weeks of ineffective traditional treatment including debridement, anti-infection and growth factor therapy, Buck in situ tissue regeneration technology was used. Following the principle of “no resection, no cauterization, no wiping”, the wound was treated with special lotion irrigation, dynamic Quan yuhegao dressing and Bake sterile application, combined with blood glucose control and anti-infection treatment. Wound healing and organ function recovery were observed. Results After 30 days of in situ regenerative repair, the full-thickness skin necrosis wound achieved complete physiological healing. The resting penile circumference recovered to 92% of the preoperative level. No severe complications such as urethral injury or erectile dysfunction occurred, and partial penectomy was avoided. Conclusion In situ tissue regeneration repair technology can safely and effectively repair full-thickness penile skin necrosis caused by diabetes combined with infection. It has significant advantages in protecting organ integrity and restoring physiological functions, and can provide a new clinical idea for refractory wounds of male genitalia.
Key words： Penile augmentation; In situ regeneration; Diabetic wound; Wound repair; Skin necrosis
参考文献 References
[1] 冯亚高,惠连旺,杨小冬.巴克无菌敷贴在小儿足部皮肤坏死缺损修复中的应用[J].国际临床研究杂 志,2023, 10:28-30.
[2] 冯亚高,惠连旺,杨小冬,等. 巴克无菌敷贴在手指皮肤坏死缺损修复中的应用[J].实用手外科杂 志,2024, 38(1):37-39.
[3] 冯亚高,惠连旺,杨小冬,等. 巴克无菌敷贴在手部部皮肤坏死缺损修复中的应用[J].临床骨科杂 志,2024, 27(2):170.
[4] 冯亚高,惠连旺,杨小冬,等.巴克无菌敷贴在手部皮肤软组织缺损修复中的临床疗效[J].实用手外科杂 志,2025, 39(1):37-40.
[5] 冯亚高,惠连旺,杨小冬,等.巴克无菌敷贴修复儿童轮辐伤致足部皮肤缺损的效果观察[J].实用手外科杂 志,2025, 39(4):432-435.
[6] 刘昭,张雪哲.阴茎增粗手术的并发症防治策略 [J]. 中华男科学杂志,2022, 28 (5):465-469.
[7] 中华医学会内分泌学分会.中国 2 型糖尿病防治指南 (2022 年版)[J]. 中华内分泌代谢杂志,2022, 38 (4):279-337.
[8] Guo S, Dipterous LA. Factors affecting wound healing [J]. J Dent Res, 2010, 89 (3):219-229.
[9] 荣新洲,张涛.外生殖器烧伤与创面修复的临床要点 [J]. 中华损伤与修复杂志 (电子版), 2021, 16 (2):99-103.
[10] 中华医学会烧伤外科学分会.糖尿病足创面修复专家共识 (2023 版)[J]. 中华烧伤杂志,2023, 39 (6):441-450.
[11] Høiby N, Bjarnsholt T, Givskov M, et al. Antibiotic resistance of biofilms in chronic infections [J]. APMIS, 2010, 118 (6-7):489-492.
[12] 付小兵,王正国,吴志谷.再生医学:原理与实践 [M]. 北京:人民卫生出版社,2013.
[13] 付小兵.中国创面修复学科建设 40 年回顾与展望 [J]. 中华创伤杂志,2021, 37 (1):1-6.
[14] 崔正军,郭鹏飞,李雯.组织原位再生技术在难愈性创面中的应用进展 [J]. 中国修复重建外科杂志,2024, 38 (2):245-250.
[15] Li H, Fu XB. Current status and progress of regenerative medicine in wound repair [J]. Burns & Trauma, 2020, 8: tkaa001.